血清AFP、FT3联合NLR对人工肝治疗乙型肝炎病毒相关慢加急性肝衰竭患者短期预后的评估价值研究

摘要 目的：探讨血清甲胎蛋白（AFP）、游离三碘甲腺原氨酸（FT3）联合中性粒细胞/淋巴细胞比值（NLR）对人工肝治疗乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者短期预后的评估价值。方法：选取2018年1月~2021年7月期间我院收治的97例HBV-ACLF患者，均成功实施人工肝治疗，作为人工肝治疗组。将人工肝治疗组的患者根据入院后90 d是否生存分为生存组69例和死亡组28例。同期选取在我院行体检的健康志愿者70例作为对照组。对比人工肝治疗组、对照组AFP、FT3、NLR。对比生存组和死亡组血清AFP、FT3、NLR。多因素Logistic回归分析短期预后的影响因素，采用预测概率值的受试者工作特征（ROC）曲线分析血清AFP、FT3联合NLR比值对人工肝治疗HBV-ACLF患者短期预后的预测价值。结果：人工肝治疗组AFP、NLR高于对照组，FT3低于对照组，组间对比差异有统计学意义（P<0.05）。死亡组AFP、NLR高于生存组，FT3低于生存组，组间对比差异有统计学意义（P<0.05）。人工肝治疗HBV-ACLF患者的短期预后与感染、国际标准化比值（INR）、终末期肝病模型（MELD）、白细胞计数（WBC）、红细胞分布宽度（RDW）、总胆红素（TBIL）、肌酐（Cr）、血清钠、C反应蛋白（CRP）有关（P<0.05）。多因素Logistic回归分析显示，RDW、AFP、INR、NLR、TBIL均为人工肝治疗HBV-ACLF患者短期预后的危险因素，而FT3则为人工肝治疗HBV-ACLF患者短期预后的保护因素（P＜0.05）。AFP、FT3、NLR联合预测人工肝治疗HBV-ACLF患者短期预后的曲线下面积（AUC）大于AFP、FT3、NLR的单独预测。结论：RDW、AFP、INR、FT3、NLR、TBIL均为人工肝治疗HBV-ACLF患者短期预后的影响因素，且AFP、FT3、NLR联合预测此类患者短期预后转归的预测价值较高。

Evaluation Value Study of Serum AFP, FT3 Combined with NLR on Short-Term Prognosis of Patients with Hepatitis B Virus Associated Acute-On-Chronic Liver Failure Treated with Artificial Liver

ABSTRACT Objective: To investigate the evaluation value of serum alpha fetoprotein (AFP), free triiodothyronine(FT3) combined with neutrophil/lymphocyte(NLR) ratio on the short-term prognosis of patients with hepatitis B virus associated acute-on-chronic liver failure(HBV-ACLF) treated with artificial liver. Methods: 97 patients with HBV-ACLF who were treated in our hospital from January 2018 to July 2021 were selected, and they were successfully treated with artificial liver as the artificial liver treatment group. The patients in the artificial liver treatment group were divided into 69 cases in the survival group and 28 cases in the death group according to whether they survived 90 days after admission. In the same period, 70 volunteers who underwent physical examination in our hospital were selected as the control group. The AFP, FT3 and NLR in artificial liver treatment group and control group were compared. The serum AFP, FT3 and NLR in survival group and death group were compared. Multivariate Logistic regression was used to analyze the influencing factors of short-term prognosis. The receiver operating characteristic (ROC) curve with predictive probability value was used to analyze the predictive value of serum AFP, FT3 and NLR ratio for short-term prognosis of patients with HBV-ACLF treated with artificial liver. Results: AFP and NLR in the artificial liver treatment group were higher than those in the control group, and FT3 was lower than that in the control group, there were significant differences between the groups(P<0.05). AFP and NLR in the death group were higher than those in the survival group, and FT3 was lower than that in the survival group, there were significant differences between the two groups (P<0.05). The short-term prognosis of patients with HBV-ACLF treated with artificial liver was related to infection, international standardized ratio (INR), end-stage liver disease model (MELD), white blood cell count (WBC), red blood cell distribution width (RDW), total bilirubin (TBIL), creatinine (Cr), serum sodium and C-reactive protein (CRP) (P<0.05). Multivariate Logistic regression analysis showed that RDW, AFP, INR, NLR and TBIL were all risk factors for short-term prognosis of patients with HBV-ACLF treated with artificial liver, while FT3 was a protective factor for short-term prognosis of patients with HBV-ACLF treated with artificial liver (P<0.05). The area under the Curve (AUC) of AFP, FT3 and NLR combined to predict short-term prognosis of patients with HBV-ACLF after artificial liver treatment were greater than that of AFP, FT3 and NLR alone. Conclusion: RDW, AFP, INR, FT3, NLR and TBIL are all influencing factors for the short-term prognosis of patients with HBV-ACLF treated with artificial liver, and AFP, FT3 and NLR combined predict the short-term prognosis of such patients with high predictive value.